Author- Dr. Aparna Govil Bhasker
Bariatric and Laparoscopic Surgeon, Mumbai
One of the biggest issues with obesity is that it is still not viewed as a disease. Infact, most people across the world think that obesity is self-driven. That somehow the person who is suffering from obesity is responsible for her/his weight gain. Most people tend to think that patients suffering from severe obesity lack will-power. They are at the receiving end of weight related comments and a whole lot of unsolicited advice regarding weight loss.
When we turn our attention to patients who are actually suffering from obesity, the story is almost similar. As a bariatric surgeon, I see patients suffering from severe obesity on a daily basis. Their weight loss stories are almost identical. Most of them would start by blaming themselves. They all feel that they lack will-power and hence they are not able to stick to a weight loss plan. They also feel that they have not tried enough. Their family members echo the same thoughts. Then they recount all the various diets, gyms, slimming centres and sometimes even plastic surgery procedures like liposuction that they have undergone.
Well, it is extremely sad to be a witness to this scenario. According to me first step towards weight loss is to recognize that obesity is a disease just like any other chronic disease such as diabetes, heart disease or cancer. We need to view it in the same manner because only when we recognize a problem, can we think of possible solutions. For this we have to move away from the blame game.
There is a need to understand some facts and clear some myths before we move on to possible solutions-
- Weight gain and weight loss is not a derivative of calories alone. Reducing calories alone is not going to lead to sustained weight loss. When we go down that path, before we know it, we tend to gain all the weight back and the whole blame game restarts. People need to understand that drastic reduction of calories is not sustainable and no one can be on a crash diet forever. All it does is that it makes you more tired and hungry. You end up craving for more food and most of the times you would end up craving for all the wrong type of food. However, the environment around us makes it feel more like a personal failing. The failure is not ours at all. This thought process of eating less calories to reduce weight is guaranteed to fail. We were on the wrong track to start with.
- Obesity is not just due to lack of self-discipline. Most people think that eating more and moving less is the root cause of obesity. It is felt that lack of exercise is one of the root causes of obesity and hence increasing exercise levels must be the obvious solution for it. We also blame patients for not making adequate efforts and giving up too easily. Governments across the world have invested heavily into weight loss programs and yet there is no country in the world that has been successful in bringing down the rates of obesity. This must inspire us to think deeper. Instead of blaming patients, we need to dig deeper into pathology of obesity. In his book, The Obesity Code, Dr. Jason Fung mentions about the difference in fat percentages of men and women. Though men consume more calories all over the world, women have much more body fat percentage than men. Women also tend to gain a lot of weight during pregnancy and menopause. We need to look very carefully at the hormonal factors that are contributing to weight gain and body fat percentage.
- Eat less and move more is simply not sustainable. To move more you need more energy and hence the more you move, the more your appetite will increase. Or the less you eat, the less you will be able to move. Our body has this beautiful ability to adjust. This is called as homeostasis. If you take in more energy, body will expend the excess and if you deprive the body too much, it will work on preserving its stores. That’s basic survival.
- Genetic basis of obesity. It is well known that obesity runs in families. While there is a genetic basis, families also share the same environment, lifestyle and food habits. The debate on nature versus nurture is evergreen. However, in some Danish studies that have been done on adoptive children, it has clearly been established that adoptive children reflect the weight metrics of their biological parents. There is no correlation of their weight with adoptive parents despite sharing the same environment. Obesity is largely inherited. To the extent of 70%!
- Eating is not always a deliberate act. Though we feel that eating is a deliberate act, hunger signals are driven hormonally. We start eating when we feel hungry and we stop eating when we feel full or satiated. The same trigger of smell of good food that can compel us to eat when we are hungry may be repulsive when we are feeling full. Hunger and satiety are hormonally controlled and are not something that we can control ourselves. Sometimes these signals may go awry and that is a part of the disease process. It is a folly to think that a person can consciously control hunger or satiety.
- The set point for body weight. If we consume excess calories on a particular day, our body compensates by increasing the body metabolism and though the weight may increase temporarily, it eventually comes down to the baseline. Similarly, by eating less calories for a few days we can bring the weight down temporarily and eventually the body will respond by going back the set weight. One of the issues with obesity is that the body set weight is too high. This is one of the primary reasons why patients suffering from obesity yo-yo between weight loss and weight gain. Every time they lose weight, the body’s homeostatic mechanisms tend to bounce them back to the higher set weight. People who have been on this journey will recount about how hard it is to keep the weight off. The question is then, that whether it is possible to lower the set point for body weight?
I leave you with this question to ponder about the above points. Think over them and first of all we need to get over the perception that obesity is somehow self- induced. Watch out this space for more blogs, discussion and information about obesity. As patients suffering from obesity and as doctors and teams treating obesity, it is extremely important for all of us to first be on the same page. We need to understand the disease before we start treating it.
The Obesity Code- Jason Fung